Urinary Control after Robotic Prostate Surgery
A concern that many men understandably share in considering prostate surgery is what effect it will have on their bladder control. A major advantage of having robotic prostatectomy at Mount Sinai is that the procedure is performed by Dr. Ashutosh (Ash) K. Tewari, Chairman of the Department of Urology. One of the foremost leaders and innovators in robotic prostate surgery and prostate cancer research, Dr. Tewari has performed more than 5,500 robotic prostate cancer surgeries in the past decade.
The Advanced Robotic Technique (ART™) of prostatectomy, standardized by Dr. Tewari, utilizes an anatomic approach to surgery that does not involve the use of any thermal (heat) energy that could damage important nerves that control urinary and sexual functioning.
When the prostate gland is removed during a robotic prostatectomy, damage can occur to the urinary sphincter, resulting in temporary or permanent incontinence. Good outcomes in terms of urinary continence are determined by the surgeon’s ability to preserve and restore the pelvic male anatomy, including the urinary sphincter muscle, in such a way that it is unaffected by the removal of the prostate. Dr. Tewari has standardized an innovative and unique procedure that reflects multiple modifications to standard robotic prostatectomy in order to restore the urinary control muscles following prostate removal. This procedure allows for faster and better continence recovery.
One inherent challenge with prostate cancer surgery is that, even with the best preservation of nerves and sphincter, the prostate has to be removed, and, in certain cases, incontinence may be caused in some part by loss of the prostate. These prostate dependent cases may explain three to five percent of patients who ultimately require surgical correction to preserve continence. To address this challenge, Dr. Tewari’s ART technique not only preserves the nerves, sphincters, and supporting tissues, but also accounts for the tissue that is lost when the prostate gland is removed. Specifically, Dr. Tewari constructs a muscular tube that replaces the gap left when the prostate is removed and also serves as a dynamic muscular sling that provides extra safety at times of stress.
What to Expect Immediately After Surgery
Some men have immediate bladder control and do not leak urine after the surgery. However, for most men, regaining full control of their urine is a gradual process that occurs over a period of weeks or several months. By six months, most men who were continent before the surgery do not need any pads, and some prefer to wear just a liner for security even if they do not leak.
To hasten the recovery of urinary control, we teach our patients pelvic floor exercises to strengthen the urinary sphincter. These exercises are known as Kegel exercises. Basically, they consist of tightening the urine control muscle (the sphincter muscles) 10 to 20 times every hour to strengthen the muscle that controls urine flow. There are other behavioral strategies we may recommend as well, including timed voiding, double voiding, and reduced fluid intake, which can significantly help facilitate urinary control and can be started shortly after surgery.
Continence treatment is tailored to each patient’s medical history and physical condition, as well as personal preferences. We have a biofeedback program that speeds up the process of urinary recovery. Most patients ultimately report that a few months after the surgery, not only that they are continent but also have a stream of urine that is better than pre surgery stream (due to enlarged prostate).
We Can Help
If continence problems persist after robotic prostatectomy, the good news is that there are minimally invasive surgical options that are highly successful, such as the male urethral sling and the artificial sphincter. At Mount Sinai, these surgeries are often done on an outpatient basis. Neil Grafstein, MD, Director of Reconstructive Urology, Female Urology, and Voiding Disorders at Mount Sinai, was one of the first urologic surgeons to perform the advance sling implantation and is one of the most experienced surgeons in the nation doing sling procedures. For a consultation with Dr. Grafstein, please call 212-241-4812.